Samuel Laura, Stuart Elizabeth A, Liu Yifan, Szanton Sarah L, Clark Alexis L, Miguel Marta, Schneider Matthew, Mashrah Alymamah, Laretz Mitch, Swenor Bonnielin
Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2025 Sep 5;15(9):e101369. doi: 10.1136/bmjopen-2025-101369.
Low-income adults with disabilities experience disproportionately high rates of food insecurity and preventable healthcare utilisation. The Supplemental Nutrition Assistance Program (SNAP) can reduce food insecurity and improve health, but there are accessibility gaps in the SNAP enrolment process. Existing outreach and enrolment assistance programmes have been shown to boost SNAP enrolment, but their health effects are understudied. This study estimates the effects of a SNAP outreach and enrolment assistance programme on health outcomes among low-income adults with disabilities.
The study pragmatically evaluates a programme that provided outreach and SNAP enrolment assistance for low-income households. The study leverages a random process that selected households for one of two types of outreach, including an information-only arm and an information plus enrolment assistance arm, which formed a control group by default. The study will estimate the effect of this programme among low-income adults with disabilities using Medicaid and SNAP administrative data. Study outcomes include emergency department, hospital and long-term nursing home utilisation. SNAP enrolment and benefit amounts are secondary study outcomes and will be tested as a mediating mechanism of action. The study will test effect heterogeneity based on race, ethnicity, age and chronic conditions.
The study, which relies on deidentified data, was determined to be exempt as human subjects research by the Institutional Review Boards at Johns Hopkins Medicine and the Michigan Department of Health and Human Services. The study is being conducted in ongoing consultation with an Advisory Group of experts in food advocacy and disability advocacy. In addition to disseminating findings in peer-reviewed publications, findings will be disseminated to state decision-makers and the community in partnership with an advisory group.
低收入残疾成年人面临粮食不安全和可预防的医疗保健利用率过高的问题。补充营养援助计划（SNAP）可以减少粮食不安全并改善健康状况，但SNAP登记过程中存在可及性差距。现有的宣传和登记援助计划已被证明可以提高SNAP登记率，但其对健康的影响尚未得到充分研究。本研究估计了一项SNAP宣传和登记援助计划对低收入残疾成年人健康结果的影响。
该研究务实评估了一项为低收入家庭提供宣传和SNAP登记援助的计划。该研究利用随机过程为两种类型的宣传之一选择家庭，包括仅提供信息组和提供信息加登记援助组，默认情况下后者构成对照组。该研究将使用医疗补助和SNAP管理数据估计该计划对低收入残疾成年人的影响。研究结果包括急诊科、医院和长期疗养院的利用率。SNAP登记和福利金额是次要研究结果，并将作为作用的中介机制进行检验。该研究将根据种族、族裔、年龄和慢性病测试效果异质性。
该研究依赖去识别化数据，约翰·霍普金斯医学院和密歇根州卫生与公众服务部的机构审查委员会确定该研究作为人体研究可豁免。该研究正在与食品倡导和残疾倡导专家咨询小组进行持续磋商。除了在同行评审出版物中传播研究结果外，研究结果还将与咨询小组合作传播给州决策者和社区。
